title: Assessing medial collateral ligament knee lesions in general practice.
abstract: OBJECTIVE
  To assess the diagnostic value of history-taking and physical examination of medial collateral ligament lesions after a knee injury presenting in general practice.
  
  
  METHODS
  Patients aged 18 to 65 years with a traumatic knee injury who consulted their general practitioner within 5 weeks after trauma filled out a questionnaire, underwent a standardized physical examination, and underwent a magnetic resonance imaging scan. Logistic regression analysis was used to test possible associations between determinants from history-taking/physical examination and medial collateral ligament lesions. The diagnostic value of history-taking and physical examination was determined for those variables indicating an association (P <.15) with medial collateral ligament lesions and was assessed by sensitivity, specificity, predictive value, and likelihood ratios.
  
  
  RESULTS
  Of the 134 patients included in this study, 35 had a medial collateral ligament lesion seen on magnetic resonance imaging scan. From history-taking, the determinants "trauma by external force to leg" and "rotational trauma" showed an association with medial collateral ligament lesion after multivariate analysis (P <.15). From physical examination, "pain valgus stress 30 degrees " and "laxity valgus stress 30 degrees " showed an association (P <.15). Isolated determinants from history-taking and physical examination showed some diagnostic value; the likelihood ratio positive was 2.0 for "trauma by external force to leg" and 2.3 for "pain valgus stress 30 degrees ." Adding "pain valgus stress 30 degrees " and "laxity valgus stress 30 degrees " from physical examination to history-taking improved the diagnostic value to a likelihood ratio positive of 6.4.
  
  
  CONCLUSIONS
  Medial collateral ligament lesions are frequently seen in patients with traumatic knee injury. History-taking has a diagnostic value, while adding physical examination increases the diagnostic value.
authors.affiliation: Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands. marlous_kastelein@msn.com
authors.forename: Marlous
authors.initials: M
authors.lastname: Kastelein
authors.forename: Harry P A
authors.initials: HP
authors.lastname: Wagemakers
authors.forename: Pim A J
authors.initials: PA
authors.lastname: Luijsterburg
authors.forename: Jan A N
authors.initials: JA
authors.lastname: Verhaar
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Sita M A
authors.initials: SM
authors.lastname: Bierma-Zeinstra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000293:injuries*; D008487:Medical History Taking; D008875:Middle Aged; D010808:Physical Examination; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies